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Peri‐operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft
Author(s) -
Gerling V.,
Lahpor J. R.,
Buhre W.
Publication year - 2007
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2007.05001.x
Subject(s) - medicine , von willebrand factor , heparin , coronary artery disease , cardiopulmonary bypass , surgery , bolus (digestion) , artery , coronary artery bypass surgery , aspirin , von willebrand disease , anesthesia , hemostasis , cardiology , platelet
Summary We describe a patient with type 2N von Willebrand's disease scheduled for elective coronary artery bypass graft for severe three‐vessel coronary artery disease with involvement of the left main stem. He was given a pre‐operative bolus of 3000 IU factor VIII/Willebrand factor concentrate (∼ 40 IU.kg −1 ), followed by a continuous infusion of 3 IU.h −1 (228 IU.h −1 ) before undergoing coronary surgery with full heparinisation and cardiopulmonary bypass. There were no intra‐operative bleeding complications and only one unit of packed red blood cells was required postoperatively. Thromboprophylaxis with low‐molecular weight heparin and aspirin was given and the infusion of factor VIII/von Willebrand factor concentrate continued for 2 days. As a result of haematological monitoring, heparin therapy was changed from prophylactic to therapeutic on day 5–6 and stopped on day 7.